Lead Compliance Program Manager

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. To learn more about who we are at Point32Health, click here.

Job Summary

The Lead Compliance Program Manager will be responsible for development, implementation and management of complex compliance programs, initiatives and projects associated with federal and state regulations for multiple lines of business (Medicare, Medicaid). This work requires partnering with internal departments as well as external stakeholders including government regulators and auditors.

The Lead Compliance Program Manager will be responsible for collaborating with leadership, teams and partnering departments to define and execute strategic compliance initiatives in order to accomplish successful compliance oversight and maintain an effective compliance program.

Key Responsibilities/Duties – what you will be doing

• Support management of the compliance program key functions, including developing compliance workplans, risk assessments and monitoring programs across all elements of our effective compliance program
• Ensure ongoing compliance with established, revised, or new regulatory requirements that impact the delivery of benefits for members.

• Oversee the compliance program through employee and leadership communications, coordination of policy development and ensure accurate and timely communication to all departments.
• Conduct risk assessments and audits to identify potential compliance issues and vulnerabilities
• Evaluate and analyze regulations, interpret significance, and recommend policies to comply and apply and ensure compliance to applicable regulations.

• Manage tracking, investigation, and resolution of compliance oversight activities such as issue management, monitoring and auditing. Lead and coordinate responses to compliance violations and incidents.

• Investigate instances of suspected noncompliance within the health plan and report to appropriate management and regulatory entities.
• Effectively identify regulatory and compliance risks and provide plan of remediation.
• Apply enforcement and discipline in appropriate instances of non-compliance.
• Prepare monthly and/or quarterly compliance reporting for the organization’s leadership and organizational Committees.

Qualifications – what you need to perform the job

Education, Certification and Licensure

• Bachelor's degree in business, law, compliance, or a related field.  
• Advanced degrees and relevant certifications are a plus.

Experience (minimum years required):

• 8 or more year’s industry experience and compliance/regulatory expertise, including leading the most cross -functional high-level initiatives.

Skill Requirements

• Excellent analytical and organizational skills.
• Strong knowledge of healthcare industry, compliance principles and regulations.
• Excellent communication, negotiation, and presentation skills.
• Ability to work effectively with cross-functional teams and senior leadership.
• Proficiency in compliance management software and Microsoft Office applications.
• Analytical and problem-solving skills.
• Knowledge of incident response and investigations is an advantage.

Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):

• Must be able to work under normal office conditions and work from home as required.
• Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
• May be required to work additional hours beyond standard work schedule

Compensation & Total Rewards Overview

Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity

​Point32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we do—from product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team's strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent.  We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.